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Lifshitz M.,Medical Corps | Lifshitz M.,Ben - Gurion University of the Negev | Dwolatzky T.,Ben - Gurion University of the Negev | Dwolatzky T.,Mental Health Center | And 2 more authors.
Journal of Geriatric Psychiatry and Neurology | Year: 2012

Introduction: The English version of the Montreal Cognitive Assessment (MoCA) test has been shown to be reliable in screening for mild cognitive impairment (MCI). However, the sensitivity and specificity of the Hebrew version of this instrument are yet to be determined. Methods: The study population consisted of 2 groups of older individuals, 74 patients diagnosed with MCI and 80 patients who were cognitively asymptomatic. Cognitive evaluation included the Mini-Mental State Examination (MMSE), Mindstreams computerized cognitive assessment, and the MoCA test. Results: The Hebrew version of MoCA distinguished between cognitively asymptomatic older individuals and those with MCI, with a sensitivity of 94.6% and a specificity of 76.3%, using a cutoff of 26/30 points. Conclusions: The Hebrew version of the MoCA test is effective for identifying MCI in older patients. As a screening instrument for MCI, its higher sensitivity makes it preferable o the MMSE, which is used extensively in the clinical setting. © The Author(s) 2012.

Jeger V.,Medical Corps
Swiss medical weekly | Year: 2011

The A(H1N1)pdm09 influenza virus is a highly contagious pathogen which caused the 2009 influenza pandemic. The virus is known to affect mainly younger people and may be a problem in crowded living conditions. The aim of the study was to describe a major A(H1N1)pdm09 outbreak in a Swiss military boot camp and to develop suggestions for similar future situations. Retrospective chart analysis of a A(H1N1)pdm09 outbreak between 14 December and 23 December 2010. Symptoms, signs and lab parameters were documented. 105 of 750 male recruits were affected by the outbreak. All nasopharyngeal swabs of 16 patients with high fever were tested positive. Common clinical symptoms included high fever, myalgia and bronchitis with persistent cough and throat aches. Fever progression typically occurred in two peaks within three days. Median length of stay at the infirmary was 3 days (range: 0.5-9 days). A(H1N1)pdm09 has become a ubiquitous seasonal virus in the region. Complications were uncommon and non life threatening. In the event of new influenza outbreaks, hygienic and containment measures must be quickly and correctly implemented, in order to avoid an epidemic. This should also be considered in non-military settings like school camps or in retirement homes.

Katzenell U.,Trauma and Combat Medicine Branch | Katzenell U.,Kaplan Medical Center | Lipsky A.M.,Trauma and Combat Medicine Branch | Abramovich A.,Trauma and Combat Medicine Branch | And 5 more authors.
Journal of Trauma and Acute Care Surgery | Year: 2013

BACKGROUND: Advanced airway management is composed of a set of vital yet potentially difficult skills for the prehospital provider, with widely different clinical guidelines. In the military setting, there are few data available to inform guideline development. We reevaluated our advanced airway protocol in light of our registry data to determine if there were a preferred maximum number of endotracheal intubation (ETI) attempts; our success with cricothyroidotomy (CRIC) as a backup procedure; and whether there were cases where advanced airway interventions should possibly be avoided. METHODS: This is a descriptive, registry-based study conducted using records of the Israel Defense Forces Trauma Registry at the research section of the Trauma and Combat Medicine Branch, Surgeon General's Headquarters. We included all casualties for whom ETI was the initial advanced airway maneuver, and the number of ETI attempts was known. Descriptive statistics were used. RESULTS: Of 5,553 casualties in the Israel Defense Forces Trauma Registry, 406 (7.3%) met the inclusion criteria. Successful ETI was performed in 317 casualties (78%) after any number of ETI attempts; an additional 46 (11%) underwent CRIC, and 43 (11%) had advanced airway efforts discontinued. ETI was successful in 45%, 36%, and 31% of the first, second, and third attempts, respectively, with an average of 28% success over all subsequent attempts. CRIC was successful in 43 (93%) of 46 casualties in whom it was attempted. Of the 43 casualties in whom advanced airway efforts were discontinued, 29 (67%) survived to hospital discharge. CONCLUSION: After the first ETI attempt, success with subsequent attempts tended to fall, with minimal improvement in overall ETI success seen after the third attempt. Because CRIC exhibited excellent success as a backup airway modality, we advocate controlling the airway with CRIC if ETI efforts have failed after two or three attempts. We recommend that providers reevaluate whether definitive airway control is truly necessary before each attempt to control the airway. LEVEL OF EVIDENCE: Care management, level IV. Copyright © 2013 Lippincott Williams & Wilkins.

Kieser D.C.,Medical Corps | Kieser D.C.,University of Otago | Carr D.J.,Defence Academy of the United Kingdom | Leclair S.C.J.,University of Angers | And 4 more authors.
Journal of Orthopaedic Surgery and Research | Year: 2013

Background: Current literature has shown the mechanism of how indirect fractures occur but has not determined what factors increase the risks of such fractures. The objective of this study is thus to determine the effect of clothing and soft tissue thickness on the risk of indirect fracture formation.Methods: Twenty-five fresh red deer femora embedded in ballistic gelatine were shot with varying distances off their medial cortex with a 5.56 × 45 mm North Atlantic Treaty Organization (NATO) bullet while being filmed with a slow-motion video. We compared the effect of two different gelatine depths and the effect of denim cloth laid onto the impact surface of the moulds.Results: Bullet passage in thinner moulds failed to cause fracture because the bullet exited the mould before a large expanding temporary cavity was produced. Clothing dramatically altered the size and depth of the expanding cavity, as well as increased lateral pressures, resulting in more severe fractures with greater bullet distances from the bone that can cause fracture.Conclusions: Clothing increases the risk of indirect fracture and results in larger, more superficial temporary cavities, with greater lateral pressures than are seen in unclothed specimens, resulting in more comminuted fractures. Greater tissue depth affords the 5.56 × 45 mm NATO a chance to yaw and thus develop an enlarging temporary cavity that is sufficient to cause fracture. © 2013 Kieser et al.; licensee BioMed Central Ltd.

Levine H.,Medical Corps | Levine H.,Hebrew University of Jerusalem | Balicer R.D.,Medical Corps | Balicer R.D.,Ben - Gurion University of the Negev | And 9 more authors.
Annals of Epidemiology | Year: 2012

Purpose: To assess the seroprevalence and seroconversion of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) Immunoglobulin G (IgG) antibodies and identify associated socioeconomic and smoking variables among male young adults in Israel, to explore health disparities and aid prevention efforts. Methods: A population-based seroprevalence study of EBV and CMV IgG antibodies in a systematic sample of Israeli males upon recruitment to mandatory military service during 1994-2004. Associations between socioeconomic and smoking variables and the seroprevalence of EBV/CMV were evaluated, controlling for possible confounders. A subset of seronegative subjects was assessed for seroconversion upon discharge from military service. Results: Overall seroprevalence rates were 87% for EBV and 59% for CMV. An association between the seroprevalence of EBV and CMV was observed. Seroconversion was 56% for EBV as compared with 31% for CMV. Lower paternal education was found to be associated with both EBV and CMV seroprevalence. Lower socioeconomic status, North African origin, and urban residence were found to be associated with CMV seropositivity, as was smoking for EBV seropositivity. Conclusions: Socioeconomic disparities exist in the seroprevalence rates of CMV and EBV among Israeli male young adults. The results of the study could aid public health efforts and determine target populations when a vaccine becomes available. © 2012 Elsevier Inc.

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